your health plan: a guide · answers and info anywhere, anytime your health plan’s at your fi...

Your health plan: A guide

Asuris Northwest Health 528 E Spokane Falls Blvd, Suite 301 Spokane, WA 99202

ANH-339326-19 Regular Fully Insured 2020 OE_v5.indd 1 9/6/19 10:53 AM

3 Let’s begin4 Save by staying in the network5 Access quality no matter where you roam6 Stay well with preventive care7 YourRxbenefitworkshardforyou8 ER, urgent care or telehealth: Know which to choose9 Keep your coverage close with asuris.com andourapp10 Extrahelpandresources11 Insurancetermsdefined

Tableofcontents


Let’s beginWhen you have Asuris as your health plan, you also get a partner who will be with you every step of the way. This guide explains how an Asuris health plan works and how to get the most out of your benefi ts. Here we go!

What you get with AsurisA convenient network that saves you moneyYou’ll have access to great doctors, hospitals and medical centers, plus stability, choice and discounts on care. Learn more about our network on page 4.

Preventive care Staying well is so important that every plan covers a wide range of in-network preventive services at 100%. Learn more on page 6.

Well-being programs to help you stay well Personalized support to help you meet your goals is always at your side on asuris.com and on our app. Plus, you can earn rewards for taking steps to improve your health. Learn more on pages 6 and 9.

Answers and info anywhere, anytime Your health plan’s at your fi ngertips with asuris.com and our app. Use transparency tools, like our Cost Estimator, fi nd a provider with our Find a Doctor tool, see claims and much more. Read more on page 9.

Support and discount programsSave on health-related goods, services, and programs. Caring support is available for moms-to-be and people facing health challenges. Want to talk to someone? Our award-winning Customer Service staff is looking forward to helping you. Learn more on page 10.

3Learn more on asuris.com. Or call us at 1 (888) 367-2109 (TTY: 711).

We’re here to helpCall us with your questions at 1 (888) 367–2109 (TTY: 711) Monday–Friday, 5 a.m.–8 p.m. PT, and Saturday, 8 a.m.–4:30 p.m. PT. Or sign in on asuris.com for Live Chat with Customer Service.


Need to find an in-network provider? Use our Find a Doctor tool to locate a doctor who’s in-network and close to your home or work. Get started at asuris.com or with the Asuris app.

Save by staying in the networkGetting care in your network is the best way to get your health plan to work for you.

A network is a group of doctors, hospitals and other health care providers that have worked with us to provide you with special pricing. Staying in network, whether you’re seeing your primary care provider or a specialist or even going to urgent care, helps you save because it means you qualify for this special pricing. Here’s how it works:

In network $When you stay in network, your doctor:

Cannot bill you for amounts over what we allow, which helps keep your costs low

Handles all the paperwork

Out of network $$$When you go out of network, your doctor:

Can bill you for amounts over what we allow

Doesn’t have to submit your claim for you

May require you to pay for care up front

Doesn’t have to comply with pre-authorization and medical record requirements, so your claims can be denied

VS

4 Learn more on asuris.com. Or call us at 1 (888) 367-2109 (TTY: 711).

Save on surgeries with our ASC benefit Many routine surgeries are safer and more effective in an ambulatory surgical center (ASC) instead of a hospital. You might also hear this called “day surgery” because you aren’t admitted overnight. ASCs specialize in certain services (like arthroscopic joint surgery or gallbladder surgery), so they can deliver better outcomes—and usually at a lower cost. Learn more or get a list of services that can be performed at an ASC by calling us at 1 (888) 367–2109 (TTY: 711) Monday–Friday, 5 a.m.–8 p.m. PT and Saturday 8 a.m.–4:30 p.m. PT.


Wherever you are, you have the ability to find the care you need.

Our extended Preferred Network gives you access to an expanded network of national providers—whether you’re here in the Northwest or away from home. That means convenient covered services at over one million locations nationwide.

The Asuris Preferred Network also provides discounted services, protection from balance billing, and nationwide provider search capability.

To search the Multiplan nationwide provider directory, visit multiplan.com/asuris.

Access care no matter where you roam

5Learn more on asuris.com. Or call us at 1 (888) 367-2109 (TTY: 711).


6

Stay well with preventive careThe more you know about your current health, the better. That’s what preventive care is for. It can detect health problems early on, when they’re easier to treat. And that’s why we cover the following services at 100% when you see an in-network provider.

All adultsAnnual physical exam

Blood pressure and cholesterol screenings

Colorectal cancer screening

Depression screening

Heart disease screening

Many immunizations

Sexually transmitted infections screening

Additional screenings for womenBreast cancer

Cervical cancer

Osteoporosis

All children Annual physical exam

Many immunizations

Schedule care todayCall your doctor to make an appointment. Need help understanding your network or benefi ts? Call us at 1 (888) 367-2109 (TTY: 711) or reach us on asuris.comor via our app. Some services are covered according to age. Visit asuris.com for a complete list of preventive care services covered at 100%.

Earn rewards for meeting health goalsYour health plan includes Asuris Motivate, a well-being program that rewards you for taking simple steps toward better health. Sign in to asuris.com and click on Wellness Tools to begin.

6 Learn more on asuris.com. Or call us at 1 (888) 367-2109 (TTY: 711).


7

Your Rx benefit works hard for youTake full advantage of your prescription drug coverage. We’re here to help you understand your options, stick to your treatment plan and get the safest, most effective medications at a good price.

Learn more on asuris.com. Or call us at 1 (888) 367-2109 (TTY: 711).

G O T O A S U R I S . C O M T O :

Use our powerful search tool to locate in-network pharmacies near you.

Get up to a 90-day supply of prescriptions shipped right to your doorstep with

our Home Delivery Program. Standard shipping is free, online ordering is easy,

and you’ll get 24/7/365 support from our expert pharmacy team. (You can also register &

access home delivery at alliancerxwp.com.)

Access MedSavvy® for side-by-side medication and cost comparisons, with

pharmacist-assigned grades for safety and effectiveness. Build a virtual medicine cabinet

so you can manage your medications and receive customized safety and recall alerts. And ask a registered MedSavvy pharmacist

your medication questions.

Get help managing chronic conditions and sticking to your treatment plan.

A committee of doctors and pharmacists creates and reviews our covered-drug list.

They choose medications based on effectiveness and safety, not just price.

The list includes brand and generic drugs. Both have the same strength, quality and purity, but generics usually cost 20–60% less. Ask your doctor if a generic will work for you.

You pay a copay (flat dollar amount) or coinsurance (percentage of the cost) depending on the tier your medication falls into.

HOW WE MAKE SURE YOUR MEDICATIONS ARE SAFE AND EFFECTIVE


8

ER, urgent care or telehealth: Know which to chooseWhen illness or injury strikes, it can be hard to know where to get care. Here’s how to decide.

When to go to the ER Here are some examples of when it’s best to go to the emergency room:Bleeding that doesn’t stop after 10 minutes of direct pressureSigns of a heart attack, such as chest pains that last more than two minutesSigns of stroke, such as numbness of the face and/or arm and leg on one side of the body, sudden loss of vision and loss of speechSevere shortness of breath or sudden dizzinessMajor injuries, such as broken bones, partial or total amputation of a limb, and trauma to the headCoughing up or vomiting bloodSuicidal thoughts

When to go to urgent care or use Doctor On Demand For symptoms including the following, urgent care or telehealth is the better choice. You’ll probably be seen sooner, plus the visit will be more affordable. Cuts or wounds where bleeding is controlledSprains, strains or bruisesMild or moderate asthma attacksInfections of the urinary tract, ear or upper respiratory systemFlu-like symptoms, such as sore throat, fever, coughing and congestionMild or moderate stomach pains or diarrheaRashes, insect bites or sunburns


Plan ahead When you need care in a hurry, the last thing you want to think about is your plan’s network or registering on a new website. Locate nearby in-network hospitals with ERs and in-network urgent care centers ahead of time using our Find a Doctor tool on asuris.com.

EMERGENCY ROOM $$$$$$

URGENT CARE$$$

$$$

$$$

Physician feeFacility feeTreatment costsHigher copay

$$$

Treatment costsRegular copay


9

ER, urgent care or telehealth: Know which to choose

Keep your coverage close with asuris.com and our appTake advantage of everything your Asuris membership has to offer. When you set up an account at asuris.com, you’ll be able to:

Find a doctor Easily search for doctors, specialists, clinics and pharmacies— all in your network.

Stay on top of your coverage Check your claims, view your benefits and see your deductible balance, all from your Member Dashboard. It’s a one-stop shop for your health care tools, personalized for you.

Compare costs and save moneyUse our tools to find in-network care, and get estimated out-of-pocket expenses for common treatments, procedures and services.

Make smart health care decisionsSee provider ratings and reviews, access medication comparison tools and more.

Reach for better healthGet active and meet your goals with Asuris Motivate, a personalized well-being experience. At your side every step of the way, it connects with the most popular fitness and health devices and technology to make success simpler.

Connect with usUnderstand your benefits and improve your experience by taking advantage of alerts, Live Chat with Customer Service, reminders, newsletters, web content and more.

Get discountsFrom discounted gym memberships to weight management programs, save on a variety of health and wellness services and products with Asuris Advantages.

Go mobileTap into your health with the Asuris app for on-the-go access to your benefits, member ID card and more. Learn more at asuris.com/mobile.

To set up an account, have your member ID card handy and go to asuris.com/membership.



10

Asuris AdvantagesThis members-only discount program saves you money on services that can improve your health, like gym memberships, weight loss programs, allergy treatment and alternative medicine. You can also save on pet insurance, meal services and funeral costs.

Asuris Advice24Asuris Advice24 is a toll-free, 24/7 nurse line. Registered nurses can advise you on common issues, including colds, flu, cuts and minor burns. They can also help you decide if you should see a doctor, give care instructions for minor injuries and illnesses, and more.

Asuris Bump2BabySM

Get support from caring professionals throughout your pregnancy. A registered nurse will support your doctor’s or midwife’s care and answer questions.

Asuris Care ManagementIf you have a difficult medical situation, our experienced care managers can answer questions and work with you and your doctor on a treatment plan. They also work with disease and behavioral specialists to help with chemical dependency, depression and other chronic conditions.

Asuris Utilization ManagementSome care requires approval from Asuris before you’re covered for treatment. This process helps you understand treatment options and related risks, make sure your care is supported by medical research, avoid treatment that isn’t needed or isn’t right for you and save on out-of-pocket costs by using approved services or vendors.

Extra help and resourcesThe following programs are not insurance, but they are offered in addition to your medical plan to help you get information and support when you need it.



11

Insurance terms definedAllowed amount The lower prices that in-network providers agree to accept as payment in full for the care they provide you.

Ambulatory surgical center An outpatient surgical center where you can receive certain surgeries without having to be admitted overnight to a hospital.

Coinsurance Your share of the cost for care after you pay any deductibles. It’s usually a percentage (for example, 20%).

Copay A flat dollar amount you pay for care, like a doctor’s visit or prescription drug.

Covered-drug list A list of prescription medications your plan covers. It includes brand-name, generic and specialty drugs.

Deductible The amount you pay out of your own pocket each calendar year before your plan begins to pay. Some services, such as preventive care, are covered before you meet your deductible.

Durable medical equipment (DME) Certain medical equipment that your doctor orders for medical reasons. Examples are walkers, CPAP supplies and breast pumps.

Exclusions Services your plan doesn’t cover.

Explanation of benefits (EOB) A statement that explains how much Asuris paid toward your claim and how much you owe for care.

Generic drug A prescription medication approved by the Food and Drug Administration (FDA) as having the same active ingredient(s) as the brand-name. Generally a generic works the same as a brand-name, and a preferred generic usually costs less.

Habilitative Health care services that help you keep, learn, or improve skills and functioning for daily living.

In-network providers Medical professionals and facilities that have agreed to accept a lower price (called an allowed amount) as payment in full for services they provide.

Inpatient Care you get when you’re admitted to a hospital or other facility for one or more nights.

Limitations Limits on some benefits to a set number of days or visits, or even dollar amounts, per calendar year.

Nurse line A toll-free phone line that allows you to speak to a registered nurse about health concerns.

Out-of-network providers Facilities or health professionals that are not contracted with Asuris. You usually pay more when you use out-of-network providers.

Out-of-pocket costs The costs you pay directly for covered care. Examples are coinsurance, copays and deductibles.

Out-of-pocket maximum The limit on how much you have to pay for covered care each year in the form of deductibles, copays and coinsurance. Once you meet it, your plan pays 100% for covered care for the rest of the year.

Outpatient Care you receive when you aren’t admitted overnight at facilities including ambulatory surgical centers, clinics and other places where you get care only for a day or a few hours.

Preventive services Health care, such as screenings and immunizations, that helps keep you well.

Provider A facility, doctor or other health professional that provides you with medical care.

Specialist An expert in a particular area of medicine. For example, a dermatologist, allergist or cardiologist.

Specialty drugs Drugs that treat complex conditions such as hepatitis C, MS, cancer and more.

Telehealth A benefit that connects you with a doctor over the phone or by video chat so the doctor can help you with routine needs and ailments.



ANH-339326-19/09 © 2019 Asuris Northwest Health

Asuris complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-232-8229 (TTY: 711).注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-232-8229 (TTY: 711).

Asuris Northwest Health528 East Spokane Falls Blvd, Suite 301Spokane, WA 99202

Questions? Call 1 (888) 367–2109 (TTY: 711) Monday–Friday, 5 a.m.–8 p.m. PT Saturday, 8 a.m.–4:30 p.m. PT

Stay up-to-dateLearn more about your health plan with asuris.com and the Asuris app.


your health plan: a guide · answers and info anywhere, anytime your health plan’s at your fi...

Documents